title: Pituitary dysfunction after blast traumatic brain injury: The UK BIOSAP study.
abstract: OBJECTIVE
  Pituitary dysfunction is a recognized consequence of traumatic brain injury (TBI) that causes cognitive, psychological, and metabolic impairment. Hormone replacement offers a therapeutic opportunity. Blast TBI (bTBI) from improvised explosive devices is commonly seen in soldiers returning from recent conflicts. We investigated: (1) the prevalence and consequences of pituitary dysfunction following moderate to severe bTBI and (2) whether it is associated with particular patterns of brain injury.
  
  
  METHODS
  Nineteen male soldiers with moderate to severe bTBI (median age = 28.3 years) and 39 male controls with moderate to severe nonblast TBI (nbTBI; median age = 32.3 years) underwent full dynamic endocrine assessment between 2 and 48 months after injury. In addition, soldiers had structural brain magnetic resonance imaging, including diffusion tensor imaging (DTI), and cognitive assessment.
  
  
  RESULTS
  Six of 19 (32.0%) soldiers with bTBI, but only 1 of 39 (2.6%) nbTBI controls, had anterior pituitary dysfunction (p = 0.004). Two soldiers had hyperprolactinemia, 2 had growth hormone (GH) deficiency, 1 had adrenocorticotropic hormone (ACTH) deficiency, and 1 had combined GH/ACTH/gonadotrophin deficiency. DTI measures of white matter structure showed greater traumatic axonal injury in the cerebellum and corpus callosum in those soldiers with pituitary dysfunction than in those without. Soldiers with pituitary dysfunction after bTBI also had a higher prevalence of skull/facial fractures and worse cognitive function. Four soldiers (21.1%) commenced hormone replacement(s) for hypopituitarism.
  
  
  CONCLUSIONS
  We reveal a high prevalence of anterior pituitary dysfunction in soldiers suffering moderate to severe bTBI, which was more frequent than in a matched group of civilian moderate to severe nbTBI subjects. We recommend that all patients with moderate to severe bTBI should routinely have comprehensive assessment of endocrine function.
authors.affiliation: Computational Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences Imperial College London, Hammersmith Hospital, London; Royal Centre for Defence Medicine, Academic Department of Military Surgery and Trauma, Birmingham.
authors.forename: David
authors.initials: D
authors.lastname: Baxter
authors.forename: David J
authors.initials: DJ
authors.lastname: Sharp
authors.forename: Claire
authors.initials: C
authors.lastname: Feeney
authors.forename: Debbie
authors.initials: D
authors.lastname: Papadopoulou
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Ham
authors.forename: Sagar
authors.initials: S
authors.lastname: Jilka
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Hellyer
authors.forename: Maneesh C
authors.initials: MC
authors.lastname: Patel
authors.forename: Alexander N
authors.initials: AN
authors.lastname: Bennett
authors.forename: Alan
authors.initials: A
authors.lastname: Mistlin
authors.forename: Emer
authors.initials: E
authors.lastname: McGilloway
authors.forename: Mark
authors.initials: M
authors.lastname: Midwinter
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Goldstone
mesh_terms: D000328:Adult; D016880:Anisotropy; D001753:Blast Injuries / Q000150:complications*; D001930:Brain Injuries / Q000150:complications* / Q000453:epidemiology / Q000209:etiology*; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D009483:Neuropsychological Tests; D010900:Pituitary Diseases / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D015995:Prevalence; D011788:Quality of Life; D012720:Severity of Illness Index; D055815:Young Adult